Provider Demographics
NPI:1841236494
Name:MILLER-MCCLUNG INC.
Entity Type:Organization
Organization Name:MILLER-MCCLUNG INC.
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MCCLUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPH, CPED
Authorized Official - Phone:580-248-7360
Mailing Address - Street 1:12 NW SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6304
Mailing Address - Country:US
Mailing Address - Phone:580-248-7360
Mailing Address - Fax:580-248-7589
Practice Address - Street 1:12 NW SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6304
Practice Address - Country:US
Practice Address - Phone:580-248-7360
Practice Address - Fax:580-248-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3-5223332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3721518OtherNCPDP #
OK3721518OtherNCPDP #
OK1229130001Medicare NSC